PeaceHealth Palliative Care (full version)

PeaceHealth Palliative Care (full version)



good evening everybody we're delighted you're all here and interested in outpatient palliative care it's an honor in this group especially to give this talk with those of you who have had someone close to you with a chronic serious illness like art failure chronic lung disease cancer diabetes or dementia please raise their hand then you know how complicated heart-wrenching and expensive the management of their disease symptoms and quality of life can be how many of you think you may be called upon in the future to help care for someone with a serious illness or even yourself because when one person in the family becomes ill the whole family experiences the illness now thanks to advances in modern medicine Americans are living longer fuller lives even with chronic serious illness long periods of physical dependency however are still common and such patients on average see 13 physicians a year and today's somewhat fragmented health care system has not kept pace with the management of serious illness and it makes it difficult to effectively treat these patients just when these numbers and and needs are growing exponentially we've all experienced what it feels like to be rushed through a doctor's visit a visit where there was not time to talk deeply and broadly and to address multiple real concerns and sadly in some cases where this occurs care can suffer from miscommunication between physicians patients can be confused about multiple prescriptions and treatments and redundant testing or even unnecessary treatments might occur in years past our family doctor used to manage most to this and now may still have time to manage a single important clinical problem in a visit like COPD but is really too busy to coordinate the complex mix of clinical emotional social and spiritual care to meet the patient's needs and goals to optimize useful care and to avoid unnecessary care and the treatment burden that may go along with it so doctors have existed in every society and culture to guide and accompany patients through serious illness and as these patients now are our sickest and most vulnerable patients both the patient and the physician need help we need to team a whole team a palliative care team who all together act like a concierge at a fine hotel who guides you on your journey to the fine restaurants tours hikes and special sites that you might not see otherwise making your visit full enjoyable enjoyable and memorable we need a concierge palliative care team to many symptoms like pain fatigue and depression and physical symptoms are not even the patient's biggest concern often fear of disability of dying of suffering of losing your job of not being able to take care of your own family and of course financial concerns are more commonly what patients lose sleep over consider these statistics mm-hmm today about 90 million Americans or 25% of the American population live with serious illness and understandably account for about 66 percent or two-thirds of us health care costs this number of patients is expected to more than double in the next 25 years possibly becoming 40 to 50 percent of the population in – and 2045 of these 90 million patients it's thought that at least six million of these should have palliative care this is 2% of our population this proportion if we look at it in Whatcom County would mean about 4,500 patients who would benefit from this so locally for example peace health clinics care for 1,500 diabetic patients 2,000 patients at our Cancer Center and fully 27,000 patients at our cardiovascular center with 4,000 cardiology consult new newly coming every year early referral to outpatient palliative care could relieve some of the burden on these busy specialties and clinics so a more intelligent paradigm is clearly needed palliative care is that paradigm so what is it what is palliative care and how does it work for the individual patient well say a patient diagnosed with a serious illness like stage four cancer is ideally referred early in the diagnosis even during the first visit to or at any stage in the illness for that matter to a palliative care team of physicians nurses social workers chaplains and volunteers who have the time and skilled communication with the patient and the family and everyone else on the T on the team to do four main things one many symptoms like pain fatigue depression and difficulty sleeping – to customize care to the individual patients needs wishes and goals and their physical emotional social and spiritual needs and honor their wishes at each visit and allow the patient through education and family to understand their treatment the kind of issues they can they might meet and and put those wishes into advanced healthcare directives 3 the team coordinates treatments medications and appointments so the patient doesn't have to manage their own complex care plan alone and for the team meets on a weekly basis to discuss every patient's integrated palliative care and all this as you can imagine is extremely fulfilling to our palliative care team and the patient we would like to clarify that palliative care is not the same as hospice Hospice is reserved for terminally ill patients in the last six months of life when treatment can no longer cure but certain treatments can certainly comfort palliative care on the other hand begins ideally a diagnosis of a serious illness it can be started at any stage during the illness it's appropriate any age and can be incorporated alongside life prolonging and curative treatments it can be provided regardless of whether the diagnosis is terminal or non terminal and is normally continued right through hospice later at the end of life so palliative care doesn't require Hospice but it's always almost always given as part of hospice this is already fortunately a national international and local movement in Washington state for example sixty-five percent of hospitals have palliative care programs nationally 77 percent of hospitals our size have these programs and at hospitals larger than st. Joe's fully ninety three percent of hospitals have programs so palliative care programs are now the rule in the United States hospitals not the exception on an international level in the year 2000 palliative care was included in the United Nations International Covenant on economic social and cultural rights in 2013 essential medicines for palliative care were included in the World Health Organization's essential medicines list and in 2014 the World Health or the World Health Assembly passed a resolution appealing to member countries to include palliative care ended into their mainstream healthcare system locally you'll be glad to hear that the inpatient and outpatient care have already begun we have been working hard on this a lot of people in this room seven years ago in 2012 due to the great generosity and venture philanthropy of the River Styx Foundation Jim Swift we brought inpatient palliative care to our Hospital this was kick-started by these foundation funds for the first three years and the hospital took over what became a largely self-sustaining Prieto process in 2015 three years later since 2012 the inpatient palliative care program has provided 4187 consultations so you can see the need for palliative care in the hospital and afterwards is great the outpatient program you'll be glad to hear has started last September 2018 we currently have 74 patients enrolled working with the team and we hope to have a hundred or so by this coming September and then by two at 2024 and five years hope to be serving about 250 patients annual the goals of inpatient and outpatient palliative care I should mention are the same the only difference is of location patients need not be hospitalized to receive palliative care they can receive it could be Neely in their own homes in residential facilities or working even in an office setting like Meg does so visionary hospitals understand that palliative care is a triple win equally benefiting the patient the physician and the health care system and a Regents Foundation survey found that fully 96 percent of physicians support palliative care it is actually the largest growing fastest growing surgical or medical specialty in America today and every specialty really every adult in America in America would benefit by learning more about it because this is only when our culture understands it that and its value that we will truly be able to adopt it universally and have it take its place as a robust insurance benefit in essence I would say palliative care is the best care possible designed to create the space and time to treat the vast complexity of medical issues palliative care is the best care at what may be the worst time in a patient's life because it empowers the patient to live well and be treated with respect and compassion in essence this is the care we all want so why is the foundation doing this for five years four main reasons number one there are as I mentioned thousands of patients in Whatcom County right now who would benefit from this care to most palliative care services like Social Work nursing a volunteer coordination are not covered by insurance so we need to cover this gap now until private insurance Medicare and Medicaid can evolve a real a better palliative care benefit in three the hospital has asked the foundation for help in this endeavor and our board has become passionate about it and for this fundraising as all fundraising we'll free up funds for other critical projects which there are always many as Dale will tell you for right right now example the hospital is expanding medical services and lended by building a 20,000 square foot facility for medical and specialty care building a new women's health center and going to start construction soon in on a hybrid operating room for complex vascular cases the point is we can do some of these great projects without philanthropy but with philanthropy we can likely do them all and they're all important so the foundation is committed to this to provide this by first five years of kickstart funds for operational startup expenses for outpatient palliative care in Whatcom County to create a full comprehensive integrated program and build program sustainability for the hospital to take over in five years so you're probably wondering what is that sustainability program what's our plan and here's the crux of it palliative care is a value proposition for the Medical Center it improves many studies show it improves patient and family satisfaction it reduces hospital admissions 30-day hospital readmissions crisis calls to 911 see department visits it reduces ICU utilization and reduces Hospital length of stay while increasing the completion rates for advanced care directives once the patient is admitted its studied – it's known to save 9 to 25% of inpatient costs through a combination of decreased length of stay and decreased cost per day outpatient palliative care programs have shown been shown to save as much as $12,000 per enrollee and naturally allow for more timely and appropriate identification of patients for hospice and longer lengths of hospice stay which is which are needed our projection is for 80 additional hospice referrals to welcome hospice every year and a 10 day increase in the length of hospice day both of which would help pay for the outpatient program when the hospital takes over info years because palliative care focuses on the highest need and highest cost patients it's a great strategy for population health management to reduce cost and improve outcomes both parts of our mission they say a palliative care could fully penetrate all the hospitals in the United States the savings annually would be six billion dollars so as you can tell we're energized about the success of palliative care so far in our community we know it's the right thing to do we would like you to join us in our commitment to make outpatient palliative care the best care possible for our most vulnerable sickest patients to enable them to continue to live well I have how do patients now about the care that's provided or that's available right so I think it's a it's a slow cultural adoption process that will probably take quite a while physicians need to educate their patients patients need educating themselves you know I think probably more community-wide forums could probably be helpful too we are also providing a palliative care Academy for a lot of community providers that we've offered to primary care and specialists and we've had a lot of participation in that to continue that education so that folks know what what it is how to have those discussions and when to refer we're telling more and more people every day and opening those referrals we've built that into our electronic medical record so that our providers know how to refer and make that easier but that's a slow process that we've been doing to continue to do the education in our community where do we go from tonight we talked about community education continue this conversation I think one thing that we've all discussed on here is making sure that we use the word palliative care make sure we're telling our family and our friends and our neighbors and then in the following weeks we'll be reaching out to you and asking if this is a project that you would like to support and ask those questions if there's board members or palliative care committee members we're here – we're here to answer questions so thank you [Applause]

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